Does Medicare cover Humira in Florida?

What Humira is used for

Humira is an injectable biologic (a TNF blocker). Its FDA label covers rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, plaque psoriasis, hidradenitis suppurativa and uveitis.

This page explains Medicare coverage only. Questions about whether Humira is right for you belong with your prescriber.

Which part of Medicare covers Humira

Humira is a pen or prefilled syringe you use at home, so it's a Part D drug. Medicare.gov says Part B covers most injectable and infused drugs when a licensed medical provider gives them; a drug you inject yourself at home falls under Part D instead. Humira is a specialty drug, so plans may require prior authorization and may require you to fill it at a specialty pharmacy that ships to your home.

Is Humira on Medicare's negotiated-price list?

No. Humira is not among the drugs CMS has selected for the Medicare Drug Price Negotiation Program so far: the 10 drugs with negotiated prices since January 1, 2026, the 15 with negotiated prices starting January 1, 2027, and the 15 CMS selected on January 27, 2026, for prices that take effect in 2028. The program only selects drugs without generic or biosimilar competition, and Humira has biosimilars.

Biosimilars and substitution in Florida

FDA licensed the first adalimumab biosimilar in 2016, and several are now on the market; FDA's Purple Book lists each one and whether it's rated interchangeable. CMS describes a biosimilar as highly similar to the original biologic, with no clinically meaningful differences in safety and effectiveness. At a Florida pharmacy, the interchangeable rating is what matters:

• When a pharmacist can switch you. Under s. 465.0252, Florida Statutes, a pharmacist may dispense a substitute for a prescribed biologic like Humira only if FDA has determined the substitute is biosimilar and interchangeable, and your prescriber hasn't expressed a preference against substitution, in writing, verbally or electronically.
• You're told. The pharmacist must notify you of the substitution, the same way Florida's generic-substitution law requires, and keep a record of it for at least two years.
• A non-interchangeable biosimilar needs a new prescription naming it. If your plan's formulary covers only a biosimilar, your prescriber can write for it or ask the plan for an exception to keep you on Humira.

If your plan switches adalimumab products for 2027, the Annual Notice of Change says so; talk with your prescriber before you switch.

What you pay for Humira in 2027: the out-of-pocket cap

Your cost for Humira depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:

• 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
• The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
• Only covered drugs count. If your plan doesn't cover Humira and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.

Spreading the cost: the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when your costs are high early in the year. With a high-cost specialty drug like Humira, spreading the cost can make a big difference to your monthly budget, even though the total doesn't change. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?

Extra Help with Humira

Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have full Florida Medicaid, SSI or a Medicare Savings Program (QMB, SLMB or QI-1, which you apply for through ACCESS Florida, run by the Department of Children and Families). Otherwise, apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213 (TTY 1-800-325-0778). Florida has no state drug-assistance program for seniors, so Extra Help is the main public help with Part D costs. See Extra Help in Florida and does Florida have a state drug program for seniors?

Getting Humira covered in Florida

Florida is its own Part D region (PDP Region 11), so each standalone Part D plan sold here is offered in all 67 counties. For 2027, CMS lists 11 standalone Part D plans from 6 companies in Florida. Every county also has Medicare Advantage plans open to everyone, from 7 in Monroe County to 52 in Hillsborough County. Each plan has its own formulary, so one plan's coverage of Humira tells you nothing about another's. Your county's numbers are on Florida counties.

Hurricane season: Humira must be refrigerated. The label allows it to be kept at room temperature, up to 77°F, for up to 14 days, protected from light, and says to throw it away after that; a Florida house without power or air conditioning can easily pass 77°F. If your specialty pharmacy ships to your home, ask before a storm how it handles deliveries, and call your plan if your supply is ruined. Medicare.gov says that if you live in a declared disaster area, your drug plan can help you find another in-network pharmacy, replace drugs that were lost, damaged or left behind when you evacuated, and fill prescriptions at an out-of-network pharmacy when you can't reasonably reach a network one (keep your receipts). CMS guidance also expects Medicare drug plans to lift "refill-too-soon" limits after a federal disaster declaration. Florida's emergency-refill law (s. 252.358) makes insurers and HMOs licensed by the Office of Insurance Regulation allow early refills when your county is under a hurricane warning or a state of emergency, but it doesn't mention Medicare, so ask your Medicare plan directly. See early refills before a hurricane.

State Group Insurance retirees: if you keep State of Florida retiree coverage once you have Medicare, the State's secondary PPO or HMO plan includes prescription drug coverage the State says is creditable (as good as Part D), so you don't need a separate Part D plan, and the State's group Medicare Advantage (MA-PD) plans include Part D. Either way, Humira follows the State plan's drug rules. The State says a retiree who cancels State coverage can't re-enroll later, so call People First (866-663-4735) before joining any outside Medicare plan. See Florida state retirees and Medicare.

Medicare and Florida Medicaid: if you have full Medicaid and Medicare, your Medicare drug coverage, not Medicaid, pays for Part D drugs like Humira, and you get Extra Help automatically. In Florida, people with Medicare usually get full Medicaid through SSI, Medically Needy (share of cost) or long-term-care Medicaid: MEDS-AD, the program for aged and disabled adults, leaves out people on Medicare unless they're getting nursing-home, hospice or home and community-based care. See Florida Medicaid and Medicare.

Plans ending in 2027: at least 302,773 Floridians in regular Medicare Advantage plans that are leaving or ending must choose new coverage for 2027. If yours is one, your plan sends a non-renewal letter and you have a special enrollment period through February 28, 2027; to keep Humira covered without a gap, choose new drug coverage by December 31, 2026. See plans ending in 2027.

Snowbirds: a Florida Part D plan's service area is Florida, and you can belong to only one Part D plan, tied to your permanent home. If you spend part of the year in another state, ask the plan whether its pharmacy network includes pharmacies where you'll be, or whether it offers mail order, before you leave with your Humira. A Part D plan disenrolls you only after more than 12 months away. See snowbird prescriptions.

How to check whether a plan covers Humira

1. Write down the exact drug. Name, strength and how often you take it. Plans list Humira and each adalimumab biosimilar separately, and may cover only some of them.
2. Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Humira and any rules.
3. Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
4. Check your 2027 notice. Your plan's Annual Notice of Change says whether Humira stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
5. Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

If your plan doesn't cover Humira, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in Florida?

Sources

• National Library of Medicine — DailyMed: Humira prescribing information (FDA label, including storage)
• FDA — Purple Book: database of licensed biological products, including biosimilars and interchangeables
• Florida Statutes — s. 465.0252, substitution of interchangeable biosimilar products
• Medicare.gov — Prescription drugs (outpatient): what Part B covers
• Florida Division of State Group Insurance — Frequently asked questions: retirees (Medicare, Part D, re-enrollment)
• Florida DCF — ESS Program Policy Manual, chapter 2000 (MEDS-AD, QMB, SLMB, QI-1)
• Medicare.gov — Drug coverage (Part D)
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program; data file of November 2, 2026)
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold, deductible and Extra Help copays)
• Medicare.gov — Medicare Prescription Payment Plan
• Social Security — Extra Help with Medicare prescription drug plan costs
• eCFR — 42 CFR 423.120 (formularies and transition fills)
• CMS — Medicare Advantage and Part D Landscape files, 2027 (PDP Region 11: Florida)
• Medicare.gov — Getting drugs in a disaster or emergency
• CMS — Pharmacy access during a federal disaster declaration: Q&As for Part D plan sponsors (2017)
• Florida Statutes — s. 252.358, emergency prescription refills

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